Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts
Objective Precision medicine in rheumatoid arthritis (RA) requires a good understanding of treatment outcomes and often collaborative efforts that call for data harmonisation. We aimed to describe how harmonisation across study cohorts can be achieved and investigate how the observed proportions rea...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-09-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/9/3/e003027.full |
| _version_ | 1797311653610520576 |
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| author | Bente Glintborg Merete Lund Hetland Ellen-Margrethe Hauge Joseph Sexton Johan Askling Niels Steen Krogh Hilde Berner Hammer Saedis Saevarsdottir Helga Westerlind Isabel Martinez Tejada |
| author_facet | Bente Glintborg Merete Lund Hetland Ellen-Margrethe Hauge Joseph Sexton Johan Askling Niels Steen Krogh Hilde Berner Hammer Saedis Saevarsdottir Helga Westerlind Isabel Martinez Tejada |
| author_sort | Bente Glintborg |
| collection | DOAJ |
| description | Objective Precision medicine in rheumatoid arthritis (RA) requires a good understanding of treatment outcomes and often collaborative efforts that call for data harmonisation. We aimed to describe how harmonisation across study cohorts can be achieved and investigate how the observed proportions reaching remission vary across remission criteria, study types, disease-modifying antirheumatic drugs (DMARDs) and countries, and how they relate to other treatment outcomes.Methods We used data from eight existing large-scale, clinical RA registers and a pragmatic trial from Sweden, Denmark and Norway. In these, we defined three types of treatment cohorts; methotrexate monotherapy (as first DMARD), tumour necrosis factor inhibitors (TNFi) (as first biological DMARD) and rituximab. We developed a harmonised study protocol defining time points during 36 months of follow-up, collected clinical visit data on treatment response, retention, persistence and six alternative definitions of remission, and investigated how these outcomes differed within and between cohorts, by treatment.Results Cohort sizes ranged from ~50 to 22 000 patients with RA. The proportions reaching each outcome varied across outcome metric, but with small to modest variations within and between cohorts, countries and treatment. Retention and persistence rates were high (>50% at 1 year), yet <33% of patients starting methotrexate or TNFi, and only 10% starting rituximab, remained on drug without other DMARDs added and achieved American Congress of Rheumatology/European Alliance of Associations for Rheumatology or Simplified Disease Activity Index remission at 1 year.Conclusion Harmonisation of data from different RA data sources can be achieved without compromising internal validity or generalisability. The low proportions reaching remission, point to an unmet need for treatment optimisation in RA. |
| first_indexed | 2024-03-08T02:03:44Z |
| format | Article |
| id | doaj.art-774319055fa24eb9ab6efad2877ffc08 |
| institution | Directory Open Access Journal |
| issn | 2056-5933 |
| language | English |
| last_indexed | 2024-03-08T02:03:44Z |
| publishDate | 2023-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj.art-774319055fa24eb9ab6efad2877ffc082024-02-14T03:40:08ZengBMJ Publishing GroupRMD Open2056-59332023-09-019310.1136/rmdopen-2023-003027Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohortsBente Glintborg0Merete Lund Hetland1Ellen-Margrethe Hauge2Joseph Sexton3Johan Askling4Niels Steen Krogh5Hilde Berner Hammer6Saedis Saevarsdottir7Helga Westerlind8Isabel Martinez Tejada9Department of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkDepartment of Rheumatology, Aarhus University Hospital Skejby, Aarhus, DenmarkCenter for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, NorwayClinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, SwedenDANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, DenmarkCenter for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, NorwayClinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, SwedenClinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, SwedenDANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, DenmarkObjective Precision medicine in rheumatoid arthritis (RA) requires a good understanding of treatment outcomes and often collaborative efforts that call for data harmonisation. We aimed to describe how harmonisation across study cohorts can be achieved and investigate how the observed proportions reaching remission vary across remission criteria, study types, disease-modifying antirheumatic drugs (DMARDs) and countries, and how they relate to other treatment outcomes.Methods We used data from eight existing large-scale, clinical RA registers and a pragmatic trial from Sweden, Denmark and Norway. In these, we defined three types of treatment cohorts; methotrexate monotherapy (as first DMARD), tumour necrosis factor inhibitors (TNFi) (as first biological DMARD) and rituximab. We developed a harmonised study protocol defining time points during 36 months of follow-up, collected clinical visit data on treatment response, retention, persistence and six alternative definitions of remission, and investigated how these outcomes differed within and between cohorts, by treatment.Results Cohort sizes ranged from ~50 to 22 000 patients with RA. The proportions reaching each outcome varied across outcome metric, but with small to modest variations within and between cohorts, countries and treatment. Retention and persistence rates were high (>50% at 1 year), yet <33% of patients starting methotrexate or TNFi, and only 10% starting rituximab, remained on drug without other DMARDs added and achieved American Congress of Rheumatology/European Alliance of Associations for Rheumatology or Simplified Disease Activity Index remission at 1 year.Conclusion Harmonisation of data from different RA data sources can be achieved without compromising internal validity or generalisability. The low proportions reaching remission, point to an unmet need for treatment optimisation in RA.https://rmdopen.bmj.com/content/9/3/e003027.full |
| spellingShingle | Bente Glintborg Merete Lund Hetland Ellen-Margrethe Hauge Joseph Sexton Johan Askling Niels Steen Krogh Hilde Berner Hammer Saedis Saevarsdottir Helga Westerlind Isabel Martinez Tejada Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts RMD Open |
| title | Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts |
| title_full | Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts |
| title_fullStr | Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts |
| title_full_unstemmed | Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts |
| title_short | Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts |
| title_sort | remission response retention and persistence to treatment with disease modifying agents in patients with rheumatoid arthritis a study of harmonised swedish danish and norwegian cohorts |
| url | https://rmdopen.bmj.com/content/9/3/e003027.full |
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